Rethinking Thomas Insel

Every time I read a statement from the current director of the National Institute of Mental Health, Thomas Insel, I have to meditate on how good it would be if the NIMH were to hire a new director. His speech at the 2011 APA convention bash in Honolulu was apparently no exception. Psychiatric News has an article on the affair, Brain, Gene Discoveries Drive New Concept of Mental Illness.

Insel said psychiatric research today promises to produce a true science of the brain based on three core principles (see Points to Remember):

• Mental disorders are brain disorders.
• Mental disorders are developmental disorders.
• Mental disorders result from complex genetic risk plus experiential factors.

A few corrections are called for here.

1. Mental disorders are not brain disorders. Brain disorders are brain disorders.
2. Mental disorders are not developmental disorders. Developmental disorders are developmental disorders.
3. Speculations about the source of mental disorders are just that, speculations.

He draws some pretty peculiar conclusions from research in DNA.

One of the most surprising findings from the Human Genome Project has been that psychiatric disorders, unlike common medical illnesses, appear to be the result of extremely rare, but highly penetrant—or potent—genetic variations. And these variations are not associated with any specific illness, but with a variety of phenotypes recognized as mental disorders, Insel said.

Dr. Insel wants us to think a mental disorder is a brain disorder. This isn’t just semantic confusion, its definitional confusion. This is New Psych Speak talking. This is Big Brother Big Sister therapeutic nanny state propaganda. Brain is no more mind than ‘war is peace’. Perhaps a more apt analogy would be to confuse a radio with the music it plays. They are not synonymous.

After making mental disorders out to be common medical illnesses, he would base these common medical illnesses on rare genetic variations. If these common medical illnesses were based on rare genetic variations they wouldn’t be common medical illnesses. I think we’ve got a long ways to go before we can say a common mental disorder is caused by a rare genetic variation. On the other hand, I think we can safely say that every individual on earth is the result of his or her own rare genetic variation.

“Rethinking mental illness means changing the emphasis so that you make sure the worst outcomes don’t happen,” he said. “We need to ask the question, How does variation in the genome lead to changes in particular neuronal circuits, which in turn bias the way an individual deals with emotional regulation?”

Dr. Insel is confusing the thought process with the organ of thought again. If genetics explains everything then “the worst outcome” has already occurred. Research, at pains to find an organic explanation, is pursuing the genetic angle. In the process of trying to lay it all on the genome, this same research is having to bow to environmental factors more and more. Perhaps eventually the genetic factor is going to count for less and less, that is to say, perhaps the problem wasn’t so organic to begin with.